[Transient global amnesia after general anaesthesia]

Transient global amnesia is a neurological syndrome in which there is a sudden and brief inability to form new memories, as well as an intense retrograde amnesia. However, awareness, personal identity and attention remain intact. It is an uncommon condition seen after an anaesthetic procedure. There are several aetiopathogenic hypotheses (epileptic, migrainous or ischaemic origin) and triggering factors (pain, anxiety, temperature changes, exercise, Valsalva manoeuvres, diagnostic tests or certain drugs). We describe the case of a patient with a high level of pre-operative anxiety who suffered an episode of transient global amnesia after undergoing otolaryngology surgery. With an acute and continued amnesia after general anaesthesia, the first thing that must be done is to establish a suitable differencial diagnosis, which should include transient global amnesia, as this is mainly an exclusion diagnosis. Preoperative anxiety may be a triggering factor to take into account in this condition, with anxiolytic treatment prior to the surgery being important.

Rupture of the lesser gastric curvature after a Heimlich maneuver

BACKGROUND

We present a case of lesser gastric curvature injury after a Heimlich maneuver due to obstruction of the breathing tract that was repaired by laparoscopic surgery.

METHODS

A patient with perforation of the lesser gastric curvature as a result of closed abdominal traumatism was operated on using the laparoscopic approach with the use of four trocars as work openings. With this technique, the diagnosis was confirmed, the injury repaired, and the abdominal cavity washed.

RESULTS

The postoperative period was favorable and the patient was released from the hospital on day 7 without any complications.

CONCLUSIONS

Laparoscopic surgery can be technically reproduced in the treatment of gastric injury as a result of closed abdominal traumatism.

[Epidemic of pneumonia associated with mechanical ventilation in Mérida, Yucatán]

OBJECTIVE

To determine the main epidemiological, clinical, and microbiologic characteristics of an outbreak of ventilator-associated pneumonia at an intensive care unit in Yucatan.

MATERIAL AND METHODS

An 11-month prospective and observational study was designed to determine incidence, mortality, potential reservoirs, etiologic agents and antibiotic susceptibility patterns.

RESULTS

The incidence of ventilator-associated pneumonia was 74%. The crude mortality rate was 88% compared to a 19.5% expected-mortality rate. Gram-negative bacteria were isolated from 98% of the cultures, of which 46% were susceptible to third generation cephalosporins, 59% to fourth generation cephalosporins, 70% to ciprofloxacin and 100% to imipenem. Klebsiella pneumoniae and Pseudomonas aeruginosa were isolated from some of the ventilator circuits and the sink.

CONCLUSIONS

The high incidence of pneumonia and associated mortality in our intensive care unit may be attributed to the absence of infection control measures and the high prevalence of multiresistant organisms which is related to antibiotic abuse.

Antioxidant enzymatic activities in human blood cells after an allergic reaction to pollen or house dust mite

Several diseases have been related to oxidative stress. Recently, antioxidant functions have also been linked to anti-inflammatory properties. Cell defenses against reactive oxygen species include antioxidant enzymes. We studied the enzymatic antioxidant capacity in human blood of both red blood and mononuclear cells from patients suffering from an allergic reaction to pollen or house dust mite. We determined superoxide dismutases (SODs), glutathione peroxidase (GSHPx) and catalase (CAT) activities in each cell type. We also determined the extent of thiobarbituric acid reactive substances (TBARS), in order to study the correlation between the cellular enzymatic activities, the redox status and the disease. In mononuclear cells from allergic patients, SODs and CAT activities were enhanced compared to controls. Conversely, a decrease in GSHPx activity was found. In erythrocytes, higher values for GSHPx and SODs and similar CAT activities were found in allergic patients and controls. Interestingly, CuZnSOD and MnSOD activities were enhanced in the same proportion for both, erythrocytes and mononuclear cells. TBARS were also enhanced in both types of cells. The respective enzymatic imbalances in mononuclear cells and erythrocytes, namely, GSHPx/SOD and CAT/SOD, and their consequences are discussed. To our knowledge, this is the first global study of antioxidant enzymes, including TBARS level determinations, in allergy.

Laparoscopic resection of a mesenteric cyst: presentation of a new case

Mesenteric cysts are rare abdominal tumors which develop as a result of embryonic defects of the lymphatics. Symptoms derived from this pathology are vague and nonspecific, being frequently abdominal pain, heartburn, and nausea. The treatment of these tumors is complete surgical excision. The laparoscopic approach is replacing open abdominal surgical procedures. We present a case of successful laparoscopic resection of a mesenteric cyst using only three trocars.

[Postsurgical gastric bezoar: presentation of a case of esophageal impaction]

A possible late sequel of gastric surgery is the formation of a phytobezoar in stomach. The phytobezoar can undergo fragmentation and the fragments can migrate causing obstructions. We present a case of proximal migration and esophageal obstruction. Surgical treatment was needed. We analyze the causes which produce this disorder and current therapeutic measures. The literature is reviewed.

[Biofeedback as a complementary treatment in surgery for anal incontinence]

Anal incontinence is a severe condition which may be treated by surgery, with unpredictable results. Biofeedback technique is designed to re-educate the function of the anal sphincter; it employs a probe for anorectal manometry, connected to the screen of an oscilloscope. The use of this technique in 43 patients with incontinence, treated with surgery resulted in 48.1% of total continence, 39.53% of partial continence and 11.62% of null response.

[Mucinous cystadenoma of the pancreas]

Pancreatic cystadenomas are rare neoplasms that represent 10% of all benign cystic lesions of the gland. Their biological features are not clearly delimited from cystadenocarcinoma, which has a similar aspect, making exhaustive histological study necessary after exeresis. A case is presented of mucinous cystadenoma of the body-tail of the pancreas that debuted as a painful abdominal mass in a patient with a history of acute pancreatitis, simulating a pseudocyst. It was diagnosed by imaging techniques (ECHO, CAT) and later needle cytology and peroperative cystography. Treatment was corporocaudad pancreatectomy. Criteria of differential diagnosis with other benign and malignant cystic lesions of the pancreas are discussed. Present trends in surgical treatment are described and the literature is reviewed.

[Results and indications of sphincteroplasty in the treatment of complicated biliary lithiasis]

Sphincteroplasty is an internal biliary drainage technique that, along with choledochoduodenostomy, is offered to surgeons as one of the most effective techniques. We report our results and conclusions in a two-year study of a group of 46 patients. We prefer sphincteroplasty in the majority of patients with papillary sclerosis and consider it the most anatomic and physiologic drainage technique, since it eliminates the persistence of a cul de sac and the possible reflux of intestinal contents. It also permits examination of the sphincter of the Wirsung duct. We note that the classic complications of sphincteroplasty (acute pancreatitis and posterior window syndrome) are usually due to technical deficiencies.